Not smoking during pregnancy is as important for Indigenous women as it is for non-Aboriginal women, but with smoking rates in Aboriginal people three times those of the non-Aboriginal community, proactive smoking cessation campaigns must be stepped up for this population in particular, according to research published in the Medical Journal of Australia.
Dr Nicolette Hodyl, a NHMRC research fellow at the University of Adelaide's Robinson Research Institute, and her coauthors studied data from every singleton birth in South Australia between January 1999 and December 2008, using birth records of pregnancies to 4245 Aboriginal women and 167 746 non-Aboriginal women.
They found that active cigarette smoking during pregnancy was associated with an increased risk of adverse perinatal outcomes - premature labour, preterm birth, intrauterine growth restriction, and small for gestational age - for both Aboriginal and non-Aboriginal women, but the risk conferred was greater in Aboriginal women.
However, they wrote, "interactions between Aboriginal status and smoking were not significant, indicating an equal contribution of smoking to poor outcomes in both populations".
Earlier studies have shown that Aboriginal populations have much higher rates of stillbirth (13.3 v 7.1 per 1000 live births), neonatal deaths (6.9 v 2.7) and preterm deliveries (13.7% v 7.9%) than non-Aboriginal populations. Additionally, the average birthweight of Aboriginal babies is 200 grams less than non-Aboriginal babies, with more than double the incidence of low-birthweight babies (12.5% v 5.9% Australia-wide).
"Rates of smoking among Aboriginal women are three times higher than those among non- Aboriginal women", Dr Hodyl and her coauthors wrote.
"Given these statistics, a reduction in maternal smoking during pregnancy is potentially the single most effective short term method to improve perinatal outcomes for Aboriginal women.
"A concerted national approach to sustain such changes requires recognition of the impact of smoking reduction and cessation during pregnancy in improving perinatal outcomes."
The researchers said their results showed that "compared with women who smoked during pregnancy, smoking cessation during the first trimester was associated with a reduction in [risk], clearly demonstrating the benefits of smoking cessation and, to some degree, of reduced smoking in pregnancy for improved maternal and neonatal health outcomes".
Smoking cessation campaigns had faced significant barriers in most Aboriginal communities due to "a number of social, economic and domestic pressures", they wrote.
Aboriginal women attend their first antenatal appointment later in pregnancy and attend fewer visits compared with non-Aboriginal women.
"Aboriginal health programs that have successfully reduced pregnancy smoking rates are those operated primarily by Aboriginal health workers. These programs adopt an accessible model of care framework, providing clinical, social, emotional and cultural support", the researchers wrote.
"Continued support of health service models that provide such care in an appropriate culturally sensitive setting should be encouraged in order to provide equitable health care."